Provider Demographics
NPI:1518407485
Name:CAPITOL PREMIER DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:CAPITOL PREMIER DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:YAHNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-991-4455
Mailing Address - Street 1:3955 E EXPOSITION AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-5000
Mailing Address - Country:US
Mailing Address - Phone:303-991-4455
Mailing Address - Fax:303-991-4456
Practice Address - Street 1:3955 E EXPOSITION AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5000
Practice Address - Country:US
Practice Address - Phone:303-991-4455
Practice Address - Fax:303-991-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6957261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1326116328Medicaid